Mid-urethral sling

Stress urinary incontinence (SUI), referring to ‘involuntary loss of urine on effort or physical exertion, or on sneezing or coughing‘, is the most common type of urinary incontinence, affecting over 10-20% of women.

When SUI severely affects quality of life and conservative measures fail, surgery may be considered. 

Amongst the currently available surgical treatment options , mid-urethral sling (MUS) has been regarded as an effective and safe minimally invasive surgical treatment for SUI since its inception in the late 1990’s. 

The procedure involves tension-free placement of a 1 cm wide polypropylene tape or sling between the vagina and the mid-point of the urethra. 

There are three main routes for placing a MUS: 

  • retropubic 
  • transobturator
  • single-incision or ‘mini-sling’

The selection of the surgical route will depend on the experience of the treating surgeon and individual patient’s factors such as body-mass-index (BMI), previous surgery and the type of stress urinary incontinence. 

Systematic reviews of numerous studies comparing MUS with traditional SUI surgical procedures have confirmed that MUS is highly effective in the short and medium term and has all the benefits of a minimally invasive procedure, with good safety profile, less blood loss, less operative time, fewer hospital stays, fewer haematomas  and fewer wound infections. 

MUS carries  risks inherent in any surgical procedure for stress urinary incontinence as well as those risks associated with the use of permanent mesh. The former includes failure, voiding dysfunction, urinary retention, worsening or de-novo urgency, urinary tract infection, and pain related to vaginal scarring. The latter includes mesh exposure through the vagina and into the lower urinary tract. 

A detailed  Patient Information pamphlet and Consent Booklet is available at NHS Scotland Synthetic Vaginal Mesh MUT for USI

In view of recent conflicting scientific-medico-legal publicity and negative media reports concerning surgical management of pelvic organ prolapse and urinary incontinence, it is important to note that the Australian Commission Quality and Safety in Health Care, the Royal Australian and New Zealand College of Obstetricians & Gynaecologists, and and international institutions such as the International Urogynecological Association (IUGA) have  published positional statements supporting MUS as an effective and safe surgical procedure for women suffering from SUI. 

RANZCOG Position statement on MUS-(C-Gyn-32)

IUGA mid-urethral-slings

ACSQH Patient-information-resource-transvaginal-TV-mesh-Stress-Urina…